Famco important chapters ( third edition) CNS: OSCE: headache : page 560 ( remember the points mentioned in the

hx and ask for red flags) : febrile convulsion: page 894 ( remember the points mentioned in the hx) Always ask for fever and hx of rash ( to rule out meningitis) Make sure that you ask for the pink card of the child and immunization Management: put the child in left lateral position during the attack. If the attack lasts for more than 10 min give him/ her diazepam rectally and take him to the nearest health centre. Dont forget to mention about the management of fever : give paracetamol 4hrly and ibuprofen 8hrly , tapid sponging . =============================== For the written exam: Migraine : 1- You should know about the management of acute attack ( table page 562) 2- Prophylaxis (page 563) (MD question) Headache: A-cluster headache (page 564-565) 1- You must know the associated symptoms (red watery eye, runny, or blocked nose, drooping eyelid) 2- Learn the management ( rarely asked) Note: usually a clinical case is given and student has to diagnose ( easy ) B- trigeminal neuralgia: 1- You should know the presentation and associated symptoms 2- Management ( commonly asked) carbamazepine / gabapentin C- Temporal headache: 1- You must know the presentation ( 532) typical symptoms 2- Labs finding usually raised ESR . Note: to diagnose temporal headache first check the ESR followed by biopsy.

EMAN AL LAWATI / FAMCO NOTES

WARNING:
Headache is usually asked in EMQs ( extending matching questions) so make sure that learn it.

ENDOCRINOLOGY:
A- Diabetes mellitus : OSCE: hx taking station or diabetic foot examination Written exam: 1- You should know the definition of metabolic syndrome 2- Glycosylated hemoglobin tells you the average blood sugar control over the previous 6-8 weeks ( 3 months) 3- You must know everything about the first line oral hypoglycaemic agents Biguanides given to obese pts ( BMI is an important clue) Side effects: lactic acidosis Contraindications: renal, liver , serious heart disease , high alcohol intake Sulphonylureas : warn about possible hypoglycemia if meals are omitted Side effects: weight gain ( so dont prescribe for obese pts , again your clue is BMI) 4- Learn about glitazone : rosiglitazone may increase risk of coronary ischemia Pioglitazone: increases insulin sensitivity and reduces total cholesterol 5- You must learn the indications to start insulin ( 369) NOTE: if the question stem mentions that the pt is diabetic, his creatinine is high , and has hyperlipidemia ( high cholesterol ) then your answer should be pioglitazone ( because high creatinine levels indicate renal failure so metformin is contraindicated , so pioglitazone can take care of both high blood sugar and hyperlipidemia ( commonly asked question) 6- Treatment of diabetic diarrhea ( had been asked in one of the end rotation exams) page 366. Tetracycline or codeine phosphate. 7- Treatment of gastric paresis ( page 366) erythromycin/domperidone B- Thyroid: 1- You should know the Treatment of hyperthyroidism in second trimester: carbimazole . 2- You should know the lab findings of subclinical hypothyroidism ( table page 373 )

EMAN AL LAWATI / FAMCO NOTES

WARNING:
In Any question related to diabetes make sure that you look at the lab values ( if given), and the BMI.

MUSCULOSKELETAL : OSCE: -hx taking station , usually RA - joints examination : knee , shoulder , back A- Osteoarthritis: 1- You should know the risk factors ( post-meniscectomy) page 520 2- You must know the symptoms and signs 3- You must know the X-ray findings 4- Learn the management ( first line drug treatment ) page 521 ( commonly asked question) NOTE: if the question stem mentions that the pt had bilateral meniscectomy in the past , and now complains of knee pain after playing football ( what is your diagnosis) ? your answer should be osteoarthritis If the question is about the first line drug treatment of osteoarthritis ( your answer should be paracetamol) Usually symptoms and investigations are asked in MCQs , so make sure that you know them thoroughly. (joint pain , +/- stiffness , synovial thickening , deformity , effusion , crepitus , muscle weakness, wasting , loss of function) Investigations: reduced joint space , cyst , sclerosis in subchondral bone , and osteophytes . ( remember the pneumonic loss , L: loss of joint space , O: osteophytes , S: subchondral sclerosis , S: subchondral cyst ) .

EMAN AL LAWATI / FAMCO NOTES

B- RHEUMTOID ARTHRITIS: 1- You must know the symptoms and investigations NOTE: symptoms : symmetrical small joints involvement , pain, stiffness , swelling ( very important) , functional loss , joint damage and deformity . X-rays: normal periarticular osteoporosis , or soft tissue swelling , loss of joint space, erosion , join destruction CCrystal induced arthritis: 1- Gout : negative birefringent crystals . 2- Treatment: if acute attack: NSAIDs , if hx of dyspepsia then drug of choice is colchicine. 3- Treatment of chronic cases: either probenecid or allopurinol. The drug of choice depends on the scenario . always look at the lab results , if uric acid excretion is less than 1g then your answer should be probenecid ( to increase the excretion) . if the uric acid is more than 1g than drug of choice is allopurinol ( more than 1g means increased production ) D- Pseudogout : 1- You should know the positive findings seen in pts w pseudogout. NOTE: in pseudogout : X-ray : chondrocalcinosis Positive birefringent , rhomboid crystals .

DERMATOLOGY: A- Acne: 1- You must know the management of mild , moderate, and sever form of acne ( page621) NOTE: always start w topical benzoyl peroxide , then topical retinoid , then topical antibiotics , then oral antibiotics , and finally for nodular acne oral retinoid is prescribed. Remember if the question is about severe or nodular acne then your answer should be refer the pt . 2- You must know when to refer the pt to dermatology. ( page 621)

SEXUAL HEALTH AND CONTRACEPTION: A- Sexually transmitted disease : 1- You must know the treatment of Chlamydia , gonorrhea, and trichomons. EMAN AL LAWATI / FAMCO NOTES

NOTE: Chlamydia : doxycycline or azithromycin , in pregnancy erythromycin is given. Trichomonas vaginalis: fishy yellow white discharge , treatment: metronidazole. Gonorrhoea: ceftriaxone. B-Hepatits B and C ( very important) OSCE : static station ( MD , and end rotation exam) : you might be given a lab report showing elevated liver enzymes Questions: What are the abnormal findings ? What are the most likely etiology ? Answer: viral hepatitis , toxin induced hepatitis, connective tissue disease. What is the management? Viral hepatitis: supportive therapy ( bed rest , fluids) Connective tissue disease: order RF, ANA Toxin induced: drug or toxin levels in the blood Carcinoma: alpha feto protein Written exam: 1- You must know and understand the viral serology in hep B Note: -HbsAg : + if less than six months then its an acute infection -if more than 6 months = chronic infection -HbeAg: + indicates active infection ( highly infective) - HbsAb: + means pt has recovered - HbsAb + and HbsAg (neg): means pt has been immunized ( vaccinated ) - HbsAb+ and HbcAb + and HbsAg neg: means pt has developed immunity post infection - exam question ( commonly asked): HbsAg more than 6months+ and HbeAg + Answer: chronic hepatitis B w high infectivity.

EMAN AL LAWATI / FAMCO NOTES

If pt has been already vaccinated against hep B and gets a needle prick: There are two options: A- Check the antibody levels and repeat it after one month B- Check antibody levels and give a booster dose

Remember : if the antibody levels are less than 10 then a booster dose is required. Exam question: a staff nurse gets a needle prick while injecting hep B positive pt w ranitidine, she has been vaccinated 2 years back. How would you manage this case ? Answer: usually you will find one of the options ( A or B) For hep C there is no immediate action to be taken , check current antibody levels and after 3-4 months.

Chapter 23 pregnancy : A- UTI in pregnancy ( MD, end rotation exam) - Page 810 : recurrent UTIs in pregnancy should be investigated. Consider USS, or IVU > 12wk after delivery. B- Down syndrome screening: - Page 797 ( table) : 11wk , 16wk Exam question: 16wk: AFP,hCG,uE3, inhibinA EAR, NOSE , AND THROAT: A- Otitis externa: - Diagnosis: ear canal appears red, swollen, inflamed. - Management: analgesia ( paracetamol) and ear drops aluminium acetate ,steroids and antibiotics. B- Otitis media: - Diagnosis: red bulging drum - Management: supportive - When to refer the pt ( very important) if recurrent attacks more than > 4 episodes in 6 mo , or membrane perforation does not heal in less than one mo refer to ENT - When to start the antibiotics ( very important) : in children w bilateral otitis media or acute OM w otorrhoea. C- Glue ear / secretory otitis media: - Sign: dull concave drum w peripheral visible vessels , +/- fluid levels or air bubbles behind the drum( MD question) . D- Mastoditis: - Persistent throbbing earache , remember if ear drum is normal its not mastoditis . EMAN AL LAWATI / FAMCO NOTES

- Management: IV antibiotics. E- Deafness: - Presbyacusis ( MD ,EMQ ) : -

EMAN AL LAWATI / FAMCO NOTES